Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

A study published in the July issue of Economic Inquiry raises that question. With roughly two-thirds of the American population overweight or obese, have our cultural ideals of what we consider “normal weight” changed?

The study looked at economic and social factors affecting obesity rates. One element explored was the impact of societal norms or standards. According to the study’s authors, standards for acceptable body weight relax as the average weight of the population increases; in turn, people’s weights continue to rise in response to the lessening of social standards.

Public responseto the studyranges from support to outrage. While some recognize the danger of “normalizing” unhealthy weights, others are angered by the insinuation that people are unable to differentiate between “average” and “healthy.”

This discussion echoes the misunderstanding that surrounded research published in 2000. One study, which was published in the journal Obesity Research, focused on body-size acceptance. In the study, subjects were presented with nine line drawings portraying various body shapes that ranged from very thin to obese. Participants were asked to identify those body sizes that “looked okay” as well as the one they “liked best.”

Slideshow: Perspectives on obesity
In the end, 86 percent of overweight study subjects and 48 percent of obese subjects said their own shape fell within the “acceptable” range. (It is important to note that study subjects did not identify overweight and obese figures as healthy or desirable, but as acceptable.) Furthermore, 80 percent of overweight subjects and 93 percent of obese subjects identified their actual shape as different from the shape they would most like to have.

Of course, the waters get muddied a bit when we attempt to differentiate normal weight from desirable weight without offending people. Although weight is an extremely sensitive subject, the separation between normal and desirable has been successfully defined in other areas. For example, evaluation of blood cholesterol was previously based on average levels. After research showed that typical levels in the U.S. were associated with increased heart disease, a “healthy” blood cholesterol level was identified and differentiated from average blood cholesterol.

Acknowledging that you’re overweight is the first step in recognizing the health risks associated with obesity. A 2002 study, also published in Obesity Research, found that self perceptions of what is overweight were influenced by sex, race and socioeconomic status.

According to the study, Caucasian females were most likely to accurately identify themselves as overweight, while black and Hispanic men were least likely to accurately identify themselves as overweight. In summary, the study noted that only about half of all participating men correctly identified themselves as overweight compared to more than three quarters of the women. These findings are consistent with other research that suggests failure to recognize yourself as overweight is a greater problem in men.

Whether viewed as acceptable or not, overweight and obese are clearly becoming the norm in America.

This new “normal” is simply not healthy. In a culture that facilitates overeating, making life changes to promote a healthier weight can often seem overwhelming. While we may not be able to change the culture overnight, each of us can take small steps to ensure that our standard of reference is also the healthiest.